Diabetes

Updated 25 February 2016

Diabetic ketoacidosis

Diabetic ketoacidosis is a complication of diabetes.

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Summary

  • Diabetic ketoacidosis is a complication of diabetes.
  • Ketoacidosis develops when the blood becomes more acidic than body tissues due to low insulin levels.
  • Diabetic ketoacidosis is more common among type 1 diabetes patients, but also occurs in those with type 2 diabetes.
  • Cell damage from acidosis can lead to severe illness and even death. People can fall into a deep coma when treatment is delayed.

Alternative names

DKA, ketoacidosis, diabetic coma

What is diabetic ketoacidosis?

Diabetic ketoacidosis is a complication of diabetes. It is caused by the build-up of by-products of fat breakdown, called ketones. This occurs when glucose is not available as a fuel source for the body, and fat is used instead.

What causes this?

People with diabetes lack enough insulin, a hormone the body uses to process glucose for energy. When glucose cannot be adequately used , body fat is broken down instead. The by-products of fat metabolism are ketones. When fat is metabolised, ketones build up in the blood and 'spill' over into the urine. A condition called ketoacidosis develops when the blood becomes more acidic than body tissues.

Diabetic ketoacidosis may lead to the initial diagnosis of type 1 diabetes, as it is sometimes the first symptom that causes the person to seek medical attention. It can also be the result of increased insulin needs in someone already diagnosed with type 1or type 2 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases. Often, however, the cause of the DKA is not apparent.

What are the symptoms of diabetic ketoacidosis?

  • frequent urination or frequent thirst for a day or more
  • fatigue
  • nausea and vomiting
  • muscular stiffness or aching
  • mental stupor that may progress to coma
  • rapid breathing
  • fruity breath (breath odour)

Additional symptoms that may be associated with this disease:

  • headache
  • decreased consciousness
  • breathing difficulty while lying down
  • low blood pressure
  • decreased appetite
  • abdominal pain

How is diabetic ketoacidosis diagnosed?

Diabetic ketoacidosis can be detected by Means of the following signs and tests:

  • signs of dehydration
  • high blood glucose ( usually, but not always above 20 mmol/L )
  • presence of glucose and ketones in urine
  • elevated blood ketone levels .
  • serum amylase (may be falsely elevated)
  • arterial blood gas (reveals pH of less than 7.3)

This disease is known to alter the results of a number of laboratory tests which may make it difficult for the doctor to interpret results.

For instance, because patients with a DKA are often dehydrated, serum urea and electrolytes (such as sodium, potassium and phosphorus) are often elevated. Yet, there are often true urinary losses of these electrolytes which complicate interpretation.

They may furthermore have an abnormal or blunted immune system and therefore not reveal an increase in infectious markers in the blood, despite having an underlying infection present. Conversely, DKA per se may increase the white cell count or ESR in the absence of any infection.

Finally, certain parameters like amylase may be falsely elevated and mislead the clinician into making a wrong diagnosis.

How is diabetic ketoacidosis treated?

The goal of treatment is to correct elevated blood glucose levels (and the low glucose levels inside cells) by giving additional insulin, and to replace fluids lost through excessive urination and vomiting. A person with diabetes may be able to recognise the early warning signs and make appropriate corrections at home, before the condition progresses.

If ketoacidosis is severe, hospitalisation is required to control the condition. Insulin replacement will be given, fluid and electrolytes will be replaced, and the cause of the condition (such as infection) will be identified and treated.

What is the prognosis?

The mortality (death rate) of untreated DKAs is close to 100 percent - even with sophisticated treatment, mortality is around 6 percent. When treatment is delayed, the patient may fall into a profound coma.

When to call a doctor

This condition can become a medical emergency. Call your health care provider if you notice early symptoms of diabetic ketoacidosis.

Go to the emergency room if nausea, vomiting, fruity breath, mental stupor, difficulty breathing, or decreased consciousness occur.

How can diabetic ketoacidosis be prevented?

Diabetics should learn to recognise the early warning signs and symptoms of ketoacidosis. Measurement of urine ketones in diabetics with infections or other stressors can give more information than glucose measurements alone. 

Read more: 

What is Diabetes? 

Symptoms of diabetes  

Diagnosing diabetes 

 

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